Book Reviews

Ecstasy: The Complete Guide edited by Julie Holland, M.D.

Ecstasy: The Complete Guide is a mammoth, 400+ page new anthology, whose subtitle – “A Comprehensive Look at the Risks and Benefits of MDMA” – sets out the ambitious nature of the book’s scope. This extensive set of essays touches on nearly the gamut of issues surrounding Ecstasy in our society today, from a fundamental look at what is known about how MDMA works, to in-depth examinations of toxicity and risk issues, to explorations of potential psychotherapeutic and clinical use of MDMA and discussions of how policy might best be changed to accommodate MDMA research.

Before I continue, I should offer a disclaimer: I am by no means qualified to make any statements about the accuracy of the information presented here. I’m not a neuroscientist, a chemist, a psychotherapist, a mental health professional, a policy wonk, or any kind of M.D., Ph.D., or anything else. I have a bachelor’s degree in theatre, for God’s sake. It may well be the case that I am in no way, shape, or form part of the target audience for this book. By the same token, David Nichols, Ph.D., states in his chapter on “The Chemistry of MDMA” that he was asked to “Explain the molecule to the masses… Keep it elementary.” Aha! I am definitely “the masses.” In fact, the book treads a very difficult path through what may seem elementary to the authors and what may nevertheless be overwhelmingly technical to interested laypeople such as myself.

So here’s my report. There is a damn lot of information in this book, a huge heaping pile of great information to be exact, so much information that my brain definitely throbbed in protest trying to understand it all and keep it all straight. Jessica Malberg, Ph.D., and Katherine R. Bonson, Ph.D. provide an excellent introductory tour of “How MDMA Works in the Brain.” Matthew Baggot and John Mendelson, M.D. provide an exhausting and vividly good summary of the toxicology research, in a chapter called “Does MDMA Cause Brain Damage?” that was the layperson’s equivalent of learning how to speak a foreign language by being stranded without clothing or food in a war zone and having to ask around for directions to the nearest bus station. It’s the single most important chapter in the book for people wanting to educate themselves about MDMA neurotoxicity. Karl Jansen, Ph.D. provides a typically lucid description of mental health risks associated with MDMA – indeed, it’s the best of the most technical chapters at communicating clearly with a lay audience.

Then, after laying out some of the risks, we start to get into some of the potential benefits. Ralph Metzner, Ph.D. and Sophia Abramson describe “Using MDMA in Healing, Psychotherapy, and Spiritual Practice.” It’s a good thing Holland organized the book to present all the risks first, because hearing Metzner and Abramson go on about MDMA is worse than watching the movie Groove – you wind up with an immediate, pressing desire to do as big a pile of MDMA as you can get your hands on, regardless of how many axons are sacrificed in the process. The most inspiring parts of the book are a trio of essays that describe how MDMA could be used to treat Post-Traumatic Stress Disorder, depression, and schizophrenia, as well as ongoing discussions of MDMA’s use in palliative care. It is very heartening to see this kind of thinking, and to know that some of this research is actually happening in various parts of the world.

The book does, however, have its problems. In many ways, a book that calls itself The Complete Guide to anything is begging for someone to run up and shout, “Oh yeah? What about this? What about that?” In this instance, the book’s lone chapter on “The History of MDMA” is insanely underwhelming; it reads like the Cliff’s Notes to the Reader’s Digest Condensed Version of a USA Today pie chart on the subject. If you really want a thorough examination of the cultural history of MDMA, check out The Book of E by Push & Mireille Silcott, an anthology that does a far better job of digging into the explosion of Ecstasy around the world from a historical perspective. As it stands, The Complete Guide’s treatment and discussion of rave culture seems ultimately condescending and dismissive, no matter how many nice things the authors have to say about the “ideals” of rave culture. It gets very old hearing all these scientists and therapists talking about what rave culture is all about; no one would think it appropriate to ask a bunch of ravers to try and summarize toxicity research or psychotherapeutic approaches, yet apparently it’s perfectly appropriate for these folks to offer unqualified capsule reviews of why rave culture is important and what’s meaningful about it. (Note: Emanual Sferios and Douglas Rushkoff do not constitute adequate spokespeople for rave culture!) The Book of E has a lot more credibility on that subject.

This may be a symptom of the larger problem posed by the book, the fundamental problem of determining the audience for its messages. Is this book likely to convince regulatory officials to see the light and suddenly drop their opposition to MDMA? Doubtful. Is it likely to convince tens of thousands of ravers around the nation who are contributing to a massive public health problem every week to back off the little pills for a while? Doubtful. Is it likely to convince reasonably responsible recreational users that their best interests are served by letting the government control access to MDMA via the medical community? Doubtful.

But anyone with a greater than casual interest in the subject will likely find food for thought here regardless. I finished the book a couple weeks ago, and I’m still chewing on my reactions to proposed policy, proposed therapeutic frameworks, proposed definitions of “recreational” and “spiritual” use. Perhaps calling it The Complete Guide was a bit overreaching, but these folks are on a mission, so what do you expect?